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Ozzy's Report from Clare

Clare has kindly sent report to me (sorry it is a bit long).....

I think from the sounds he is sort of going to be okay.... just have to keep an eye on him.

History
Ozzy was presented with a 1 month history of ear scratching. Mrs Price noticed that Ozzy scratches his ears more than her other CKCS. The scratching is much more apparent in the early morning. There was no history of neck/shoulder scratching or sensitivity to touch(typical for syringomyelia).

Clinical findings
Ozzy’s neurological examination was normal

Assessment
Given the breed I was suspicious that Ozzy had a Chiari malformation (occipital bone hypoplasia) with or without syringomyelia. The clinical sign of rubbing ears (facial) pain is more common with Chiari malformation alone. There is still much about this disorder that we do not understand. Chiari malformation is extremely common in the breed – studies find about 90% affected. However only a proportion have pain directly related to this.

Diagnostic tests
Ozzy had a MRI scan which confirmed the Chiari malformation. In Ozzy’s case I can be more certain thet this could be related to the facial discomfort as there is considerable ventricular discomfort indicating obstruction of CSF flow at the foramen magnum.

There was a little central canal dilation in the C2-C3 region. This is the earliest stage of syringomyelia and in Ozzy’s case I do not think is clinically significant. I think that his pain is explained by the chiari malformation, the interruption to CSF flow and possibly medullary compression resulting in a neuropathic pain syndrome.

MRI of the ears including tympanic bullae was normal.

A routine haematology and biochemistry were obtained to look for any other problems that might preclude certain drug therapy. There are mild nonspecific chances

Management
As you are probably aware Chiari syndrome may be managed medically and/or surgically. In most cases without syringomyelia I use medical management.

My first choice is Frusemide on the basis that this can reduce CSF production/pressure. I have suggested a 2-4week trial of 10mg Frusemide twice daily. If this improves Ozzy’s signs then frusemide may be continued although if used on a long term basis I suggest adding an oral potassium supplement to counteract the increased potassium loss in the urine (e.g. Tumil K extrapolating from the feline dose)

Other possible management
If this is unsuccessful then instance I try NSAIDS such as Rimadyl and Metacam.

For more severe or persistent pain I use Gabapentin (Neurontin dose rate 10-20mg/kg BID/TID). This is an anticonvulsant, which has a neuromodulatory effect on hyperexcitable damaged nervous system.

These are not licenced for dogs as they are “human” drugs. The only side effect I have seen has been sedation at higher dose rates. The smallest capsule size is 100mg.

In cases with inadequate relief of pain from Gabapentin or with significant neurological deficits I use corticosteroids however in these cases surgical management should also be considered. There is also an argument in these cases for repeating the MRI scan on a yearly basis and considering surgery if syringomyelia develops.

The aim of surgery is to restore CSF dynamics. The most common procedure for Chiari like malformation is foramen magnum decompression where the supraoccipital bone and the cranial dorsal laminae of the atlas are removed (with a durotomy and expansion of the dural sac). In my experience surgery is usually successful at significantly reducing the pain and improving the neurological deficits; signs may recur in a proportion of dogs after several months/years.

Follow-up
I would appreciate a progress report on the effectiveness of the frusemide in 2-4 weeks. Please do not hesitate to contact me if you wish to discuss this case in further detail.

So have you started him on the Frusemide? Give it a few days and I'll bet you'll have a different dog Maxx is on Frusemide and occasionally Norocarp which is a generic version of Rimadyl & we have very few problems with him.

Very interesting. This is pretty much what she's said about Abbey's MRI as well. She has the malformation, but not SM (no syrinxes). Clare feels the symtoms we're seeing is due to the velocity of the CSF and has suggested Furosemide. We had her on it for months and she did really well, however, she stared having accidents at night, even with us being diligent on frequently letting her out. We decided, with our vet, to take her off the drug to see if the accidents stopped. So far they have. We're guessing she has incontinence issues due to spaying (sphincter incompetence of the urethra, common in spayed females), and that the Furosemide was making this condition worse. We're now going to try her on Gabopentin instead.

This is what I guessed in your other thread, where I explained what I thought might be happening and what Clare had found. Have a read through the human site on Chiari and SM as that should help give an easier to understand picture about what is going on. The frusemide really helps many dogs. I'm sorry that the malformation with these symptoms is confirmed but now you are able to do some intervention to help relieve the pressure and hopefully that will bring permanent relief from the scratching and stop any further issues.

That's great that the neurological exam was normal which means there's no neurological damage from the impeded CSF flow.

He has started the tablets and we have only had three accidents - two of them this morning - these were may fault though - I locked the back door to go to the shower and just remembered that I had feed him a little later than normal - and then when I was putting on my trainers to go for walkies.... already it seems that the scratching has greatly reduced - they only seem to be normal doggy scratches.

He will get better with the weeing. It took Leo about a week or two to realise he needed to hold himself and now I usually wait about 90 minutes after a pill. If I take him out too early now, he just produces more urine so I need to have the timing right (as I have to take him on a walk; I don;t have a garden to let him out in). With boys it is easier to check if they are at the point of really needing to go out as their 'wick' often gets wet.